Boletin medico del Hospital Infantil de Mexico · 2025
Use of lung ultrasound to guide surfactant administration and make differential diagnosis during immediate and transitional newborn care in a perinatal hospital.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ibarra-Ríos Daniel, Franchi Federico, Morales-Barquet Deneb A, Jorge-Chang Edgar A, Valencia-Contreras Carolina, Salgado-Valencia Juvenal, Coronado-Zarco Irma A, Sánchez-Cruz Alejandra, Márquez-González Horacio
Аннотация
INTRODUCTION: Lung ultrasound (LU) has proven to be the best method for diagnosing surfactant deficiency (Respiratory Distress Syndrome [RDS]) and continuous positive airway pressure (CPAP) failure; experience in Mexico is limited.
METHODS: The objective was to determine the usefulness of a LU program and a lung ultrasound score (LUS) for predicting surfactant need in a perinatal hospital. LUS and FiO2 of patients who received or did not receive surfactant were compared with Mann-Whitney U test. Using LU as the gold standard, FiO2 thresholds were tested using receiver operating characteristic curves.
RESULTS: 69 newborns (33 weeks [30, 35]; birth weight 1925 [1470, 2590]) were evaluated for differential diagnosis and to determine surfactant needs. 74 studies were performed: 54 for the first dose (14 administrations, 26%) and 20 for re-surfactant (six administrations, 30%). Among the group evaluated for a first dose, LU diagnoses were RDS 30%, transient tachypnea of the newborn (TTRN) 59%, TTN/air leak 6%, TTRN/pleural effusion 1.6%, congenital pneumonia 1.6%, and meconium aspiration syndrome 1.6%. There was a statistically significant difference between the LUS of patients who received the first (12 [10, 12] vs. 6 [5, 6]) and second dose of surfactant (12 [11, 12] vs. 4 [4, 7]). FiO2 ≥ 30% was found in 34% of patients with TTN pattern in whom CPAP optimization improved all cases. An optimal FiO2 threshold of 24% was found with an area under the curve of 0.85.
CONCLUSIONS: LU provides very valuable information through pattern recognition and a LUS, allowing differential diagnosis and tailored physiological care.
METHODS: The objective was to determine the usefulness of a LU program and a lung ultrasound score (LUS) for predicting surfactant need in a perinatal hospital. LUS and FiO2 of patients who received or did not receive surfactant were compared with Mann-Whitney U test. Using LU as the gold standard, FiO2 thresholds were tested using receiver operating characteristic curves.
RESULTS: 69 newborns (33 weeks [30, 35]; birth weight 1925 [1470, 2590]) were evaluated for differential diagnosis and to determine surfactant needs. 74 studies were performed: 54 for the first dose (14 administrations, 26%) and 20 for re-surfactant (six administrations, 30%). Among the group evaluated for a first dose, LU diagnoses were RDS 30%, transient tachypnea of the newborn (TTRN) 59%, TTN/air leak 6%, TTRN/pleural effusion 1.6%, congenital pneumonia 1.6%, and meconium aspiration syndrome 1.6%. There was a statistically significant difference between the LUS of patients who received the first (12 [10, 12] vs. 6 [5, 6]) and second dose of surfactant (12 [11, 12] vs. 4 [4, 7]). FiO2 ≥ 30% was found in 34% of patients with TTN pattern in whom CPAP optimization improved all cases. An optimal FiO2 threshold of 24% was found with an area under the curve of 0.85.
CONCLUSIONS: LU provides very valuable information through pattern recognition and a LUS, allowing differential diagnosis and tailored physiological care.